GAO: Medicaid duplicates efforts, needs efficiency

The Centers for Medicare & Medicaid Services established the Medicaid Integrity Group (MIG) to implement and oversee the National Medicaid Audit Program (NMAP) to fight fraud, waste and abuse. But MIG hired separate review and audit contractors to do the exact same work under the NMAP, the Government Accountability Office said in a report publicly released this week.

Both the review contractors and audit contractors evaluate whether payments violated state Medicaid policies, doubling states' administrative burden and duplicating data analysis, according to the GAO.

It cited "long-standing concerns" that include insufficient oversight and commitment, as well as a vulnerability to improper payments. The report also highlighted poor coordination and communication between both types of contractors.

Thanks to such duplication and inefficiencies, Medicaid audits took almost 23 months on average to complete, the GAO noted. In a more collaborative approach, audits lasted an average 16 months and identified more overpayments.

Earlier this summer, the GAO criticized the financial waste of anti-Medicaid fraud efforts after it found that conducting Medicaid fraud audits costs the government five times more than the amount it finds.

To improve efforts to prevent and reduce improper Medicaid payments, the GAO called on CMS Acting Administrator Marilyn Tavenner to combine contractor functions and conduct comprehensive reviews to better target audits.

The U.S. Department of Health & Human Services largely concurred with most of the GAO's recommendations for eliminating duplication and improving efficiency. However, it didn't agree with suspending a state reporting requirement that HHS said contained important data, Politico reported.

Meanwhile, in another report released to the public this week, GAO said expanding prepayment audits could save the Medicare program as much as $114.7 million.

For more:
- here's the GAO summary and report (.pdf)
- read the Politico article